MEDICARE: DR. EUGENE HERBERT SIEGEL D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	OS002616L	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	597586	OTHER	PA	MEDICARE GROUP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306826656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EUGENE HERBERT SIEGEL D.O.

Provider Business Mailing Address
First Line	:	PO BOX 820933
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19182-0933
Country	:	US
Telephone Number	:	215-342-6777
Fax Number	:	215-722-1259

Provider Business Practice Location Address
First Line	:	6410A RISING SUN AVE
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19111-5229
Country	:	US
Telephone Number	:	215-342-6777
Fax Number	:	215-722-1259

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2006
Last Update Date	:	10/21/2013

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